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Aims of the Session To give a brief overview of stoma care management and the support of the patient/family/carer Discuss the role of the Stoma Care Nurse Specialist To discuss a variety of stoma problems that patients may face To outline the management of these problems

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History First surgical stomas were created on battle casualties in the early in the early 1700s No documentation of the specific care of stoma patients in the nursing profession press until the late 1930s (Plumley,1939) The first stoma therapist was not a nurse, but a patient. Norma Gill, Ohio,USA In the UK Barbara Saunders a ward sister, set up the first stoma clinic in saw the first stoma care nursing posts

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Types of Stomas Over 80,000 people in the UK living with a stoma Stoma greek word for mouth Colostomy (wet colostomy) Ileostomy Urostomy Loop or end, permanent or temporary

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Stoma Care Nurse Specialist Some are Colorectal Nurse Specialists Present in all major hospitals in the NE Some are community based Strong network, regional meetings, patient open days, study events, collaborative working/patient referrals Sub specialist nurses in Paediatrics and Urology

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Senior Nurse who has undertaken formal training/examination in the field of stoma care/colorectal Clinical and consultative role Patient advocate, support and education Teaching Management, research, audit, change agent

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Stoma Care Management Team approach – specialist nurses, ward and community nurses, medical staff, patient, carers and family Practical Support – how to look after the stoma and surrounding skin, dietary advice, types of appliances, holiday advice Psychological Support – emotional reaction to this type of surgery, lifestyle issues, sexuality and body image Preoperative preparation including siting Post operative support and education Continued support once patient is discharged into the community Aim is for the patient to become an‘expert’ in stoma management and adapts to life with a stoma

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Stoma Problems Divided into 3 main areas 1.Problems in the management of a stoma e.g. hernia, prolapse, stenosis 2. Skin conditions which may arise due to the stoma or wearing of an appliance 3.Psychological issues

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Post op stoma shrinkage 6 to 8 weeks for stoma to shrink in diameter and spout. Patients may need to change appliance type e.g. Convex Need regular review by stoma nurse in the first 2 to 3 months.

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Prolapse Defined as when a length of bowel prolapses out onto the exterior of the abdominal wall More common in transverse loop colostomies (larger stoma) Fit larger appliance Reduce prolapse Surgical intervention

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Patient Impact Stoma formation and stoma complications can effect the physical, psychological, sexuality and social well being of the patient Loss of self-esteem Change in body image Loss of confidence Social recluse Affecting work, relationships, social activities / holidays Regular support especially early in recovery period is vital

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Patient Support Healthcare Professionals Clinical psychology National and local patient support groups e.g. Urostomy association One to one patient support Stoma appliance manufacturers, pharmacy, dispensing appliance contractors

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Conclusion Stomal problems should be assessed holistically Using multi-disciplinary team No one simple answer to any of the complications Patients need easy access to specialist nurse for ongoing advice and support Nurses need to involve other specialists where appropriate e.g. tissue viability nurse, dietitian Dealing promptly and affectively with a problem will minimise patient anxiety and promote adaptation.

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Conclusion Stoma care management can be varied, challenging and at times complex. Careful assessment, prompt management and good communication within the team is essential, as is ongoing patient support. The reward is a confident patient who is able to just get on with life.